780714

research-article2018
JOP0010.1177/0269881118780714Journal of PsychopharmacologyLemercier and Terhune

Perspectives

Psychedelics and hypnosis: Commonalities

and therapeutic implications
Clément E Lemercier1
Journal of Psychopharmacology
1­–9
© The Author(s) 2018
Reprints and permissions:
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DOI: 10.1177/0269881118780714
https://doi.org/10.1177/0269881118780714
journals.sagepub.com/home/jop

Abstract
Background: Recent research on psychedelics and hypnosis demonstrates the value of both methods in the treatment of a range of psychopathologies with
overlapping applications and neurophenomenological features. The potential of harnessing the power of suggestion to influence the phenomenological
response to psychedelics toward more therapeutic action has remained unexplored in recent research and thereby warrants empirical attention.
Aims: Here we aim to elucidate the phenomenological and neurophysiological similarities and dissimilarities between psychedelic states and hypnosis
in order to revisit how contemporary knowledge may inform their conjunct usage in psychotherapy.
Methods: We review recent advances in phenomenological and neurophysiological research on psychedelics and hypnosis, and we summarize early
investigations on the coupling of psychedelics and hypnosis in scientific and therapeutic contexts.
Results/outcomes: We highlight commonalities and differences between psychedelics and hypnosis that point to the potential efficacy of combining
the two in psychotherapy. We propose multiple research paths for coupling these two phenomena at different stages in the preparation, acute phase
and follow-up of psychedelic-assisted psychotherapy in order to prepare, guide and integrate the psychedelic experience with the aim of enhancing
therapeutic outcomes.
Conclusions/interpretation: Harnessing the power of suggestion to modulate response to psychedelics could enhance their therapeutic efficacy by
helping to increase the likelihood of positive responses, including mystical-type experiences.

Keywords
Consciousness, hypnosis, psychedelics, psychotherapy, suggestion

Introduction
Alterations of consciousness have aided therapeutic processes in a
variety of practices from ancient shamanism to approaches used in
contemporary psychotherapy (Buckley and Galanter, 1979).
Psychedelic-induced states of consciousness have been used as a
central feature of many religious, sacramental and medicinal prac-
tices in a variety of cultures (Schultes and Hofmann, 1979).
Psychedelics induce profound changes in perception, thought, affect
and self-awareness (Preller and Vollenweider, 2018) and are recog-
nized as agents capable of eliciting deeply personal and spiritually
meaningful experiences (so-called mystical-type experiences) asso-
ciated with sustained beneficial effects on personality and on psy-
chological well-being (Griffiths et al., 2008, 2011; MacLean et al.,
2011; Schmid and Liechti, 2017). In the last decade, we have wit-
nessed a surge in research exploring the impact of psychedelics, such
as lysergic acid diethylamide (LSD) and psilocybin, on psychologi-
cal and brain functions (Carhart-Harris et al., 2012, 2016b; De
Araujo et al., 2012; Kometer et al., 2015; Kraehenmann et al., 2015;
Tagliazucchi et al., 2016) and in psychotherapy (Bogenschutz et al.,
2015; Carhart-Harris et al., 2016a; Garcia-Romeu et al., 2015;
Griffiths et al., 2016; Johnson et al., 2014; Ross et al., 2016; for
reviews, see Carhart-Harris and Goodwin, 2017; Liechti, 2017). It is
increasingly being recognized that research on psychedelics has the
potential to inform our understanding of the neurobiology of psychi-
atric disorders and consciousness in general and to provide a plat-
form upon which the therapeutic benefits of alterations in
consciousness can be safely harnessed and studied.
Hypnosis began as a therapeutic discipline in the eighteenth
century and is considered as the first western conception of psy-
chotherapy: the first time a spoken interaction between a doctor
and a patient was thought to have therapeutic potential
(Ellenberger, 1970). Hypnosis is a mind–body intervention that
consists of a set of procedures comprising the administration of
verbal suggestions for alterations in affect, cognition and percep-
tion (Elkins, 2017). The therapeutic potential of hypnosis has
been documented since its origins, but it is only recently that the
method has experienced a renewed interest for clinicians with
accumulating evidence for its efficacy for the treatment of multi-
ple symptoms and conditions (Elkins et al., 2013; Hasan et al.,
2014; Patterson and Jensen, 2003; Schaefert et al., 2014; for
reviews, see Elkins, 2017; Terhune et al., 2017). Recent cognitive
and neurophysiological studies have begun to elucidate the
underlying bases of hypnosis and have shown that manipulation
of subjective awareness with hypnotic suggestion can provide
1Association AlternatiMed, Bordeaux, France
2Department of Psychology, Goldsmiths, University of London, UK
Corresponding author:
Clément E Lemercier, Association AlternatiMed, 26 rue Leydet,
Bordeaux 33800, France.
Email: clement.lemercier@alternatimed.com
2 Journal of Psychopharmacology 00(0)
insights into brain mechanisms involved in pain, perception,
attention, motor control, sense of agency and executive control
(for reviews, see Oakley and Halligan, 2013; Terhune et al.,
2017). Moreover, mounting evidence points to the promise of
using hypnotic suggestion to model and experimentally modulate
conscious states that are otherwise challenging to control, such as
pathological symptoms (Oakley and Halligan, 2013; Woody and
Szechtman, 2011) or anomalous experiences (Hastings, 2006;
Lynn and Evans, 2017; Zeev-Wolf et al., 2017).
Despite multiple phenomenological parallels, recent research
on psychedelics and hypnosis has occurred largely in isolation. By
contrast, earlier research highlighted overlapping characteristics
between these phenomena (Barber, 1970) and the potential for
joint use in psychotherapy (Levine and Ludwig, 1966; Ludwig and
Levine, 1965). In particular, the potential of harnessing the power
of suggestion to influence the response to psychedelics may have
implications for both clinical and basic research. In this article, we
review recent advances that suggest commonalities between these
two phenomena. Against this backdrop, we revisit early investiga-
tions on the coupling of psychedelics and hypnosis in scientific and
therapeutic contexts and conclude by describing potential applica-
tions of hypnosis in psychedelic-assisted psychotherapy.
Psychedelics
Classic psychedelics, such as LSD, mescaline, psilocybin, and
N,N-dimethyltryptamine (DMT), exert their hallucinatory effects
primarily through activation of serotonin 2A receptors (5-HT2A)
(González-Maeso et al., 2007; for a comprehensive review, see
Nichols, 2016). There is broad consensus that response to psych-
edelics depends on a confluence of factors referred to as ‘drug,
set, and setting’ (Zinberg, 1986). These include the drug dosage
and the user’s psychological profile, current mood state, pre-drug
history, response expectancies, and social and environmental
context. Psychedelics are generally regarded as non-addictive
(Fantegrossi et al., 2004) and as safe when used in an adapted
setting and with well-prepared participants (Johnson et al., 2008;
Schmid et al., 2015; Studerus et al., 2011). Moreover, large popu-
lation studies suggest that their long-term use is not associated
with increased risk for mental health problems (Johansen and
Krebs, 2015), but rather with reduced psychological distress and
suicidality (Hendricks et al., 2015).
Neurophysiology
The neurophysiology of the psychedelic experience has been
shown to be characterized by changes in the dynamics and con-
nectivity patterns of resting state networks (RSNs; for reviews,
see Barrett and Griffiths, 2017; Dos Santos et al., 2016).
Psychedelics induce a global increase in cerebral metabolic rate
in frontal regions of the brain (Hermle et al., 1992; Vollenweider
et al., 1997). EEG and MEG research suggests that psychedelic
states are characterized by a broadband desynchronization of cor-
tical oscillations (Kometer et al., 2015; Muthukumaraswamy
et al., 2013), including in several brain regions comprising well-
established RSNs such as the default mode network (DMN)
(Carhart-Harris et al., 2012, 2016b; Kometer et al., 2015;
Muthukumaraswamy et al., 2013; Palhano-Fontes et al., 2015).
Alteration of the efficiency of long-range communication
between nodes of the DMN, decreased integrity and increased
desegregation of RSNs (Carhart-Harris et al., 2016b; Kometer
et al., 2015; Muthukumaraswamy et al., 2013) have been pro-
posed as the mechanisms underlying psychedelic experiences
(for reviews, see Barrett and Griffiths, 2017; Dos Santos et al.,
2016). Despite some mixed and potentially conflicting evidence,
this growing body of research reveals that classic psychedelics
produce their effects by modulating cortical and subcortical
regions involved in self-awareness, perception, affect processing,
and executive and higher cognitive functions (Barrett and
Griffiths, 2017; Dos Santos et al., 2016).
Therapeutic potential
Psychedelic-assisted psychotherapy generally consists of one or
more sessions during which the patient or participant ingests a
predetermined dose of a psychedelic drug in a supportive envi-
ronment. During the session, the therapist provides generally
non-directive support for the subsequent experience of the indi-
vidual. The individual may experience a range of psychological
effects including extreme positive and negative emotions. Over
the last decade, older clinical studies have been revisited with
modern study designs, highlighting the therapeutic potential of
psychedelics (for reviews, see Carhart-Harris and Goodwin,
2017; Liechti, 2017). In particular, psychedelic-assisted psycho-
therapy seems to hold promise in the treatment of depression
(Carhart-Harris et al., 2016a), anxiety disorders (Griffiths et al.,
2016; Ross et al., 2016), and nicotine and alcohol addiction
(Bogenschutz et al., 2015; Garcia-Romeu et al., 2015; Johnson
et al., 2014). Critically, multiple studies have reported an associa-
tion between therapeutic outcome and measurable mystical-type
experiences sometimes induced by the drug, suggesting that the
nature and quality of one’s response plays a significant role in
therapeutic outcome (Bogenschutz et al., 2015; Garcia-Romeu
et al., 2015; Johnson et al., 2014; Roseman et al., 2018). Despite
the promising results of these preliminary studies, they suffer
from methodological limitations such as small sample sizes, lack
of comparison against conventional treatments and the signifi-
cant challenge of the inability to properly control for the placebo
response.
Hypnosis
Hypnosis is a unique interpersonal method in which a therapist or
experimenter uses verbal suggestion to modulate the conscious
states of a patient or participant. A session typically consists of
three phases: an induction, in which instructions and suggestions
for reduced meta-awareness and absorption in the words of the
experimenter are administered alongside the general suggestions
to enter hypnosis (Terhune and Cardeña, 2016); a suggestion
phase, in which one or more suggestions are given to modulate
the contents of consciousness; and finally a de-induction phase,
in which instructions and suggestions are administered in order
to elicit a return to normal alertness with the potential administra-
tion of posthypnotic suggestions intended to take effect follow-
ing termination of the session (e.g., Barnier and McConkey,
1999). Particularly among highly suggestible individuals, an
induction is frequently accompanied by spontaneous alterations
in self-related processing and perception (Pekala and Kumar,
Lemercier and Terhune 3
2007). However, the evidence for the importance of hypnotic
inductions in responsiveness to suggestions is mixed (Terhune
and Cardeña, 2016), thereby highlighting the potential utility of
applying suggestion in the absence of a formal induction proce-
dure. In response to specific suggestions, highly suggestible indi-
viduals are capable of experiencing pronounced alterations in
consciousness including hallucinations, amnesia and cognitive
deficits (Barnier et al., 2014). Responses to suggestions are typi-
cally accompanied by a lack of authorship over the response, as
measured by both self-report and implicit perceptual indices
(e.g., Lush et al., 2017; Polito et al., 2015), with reductions in the
sense of agency being comparable in magnitude in highly sug-
gestible individuals to phenomenological aberrations reported by
patients with schizophrenia during passivity symptoms (Polito
et al., 2015). Hypnosis can be conceptualized as a manifestation
of the broader phenomena of suggestion and suggestibility
(Halligan and Oakley, 2014) and has even been referred to as a
‘non-deceptive placebo’ (Kirsch, 1994). Response expectancies
are known to be important contributing factors to responsiveness
to both hypnotic suggestions and placebos (De Pascalis et al.,
2002; Lynn et al., 2008). However, the available evidence indi-
cates that a relationship between hypnosis and placebo, if one
exists, is potentially complex and moderated by multiple factors
(De Pascalis et al., 2002; De Pascalis and Scacchia, 2016;
McGlashan et al., 1969; Woody et al., 1997).
As measured by standard, and well-validated, behavioural
scales (for a review, see Woody and Barnier, 2008), hypnotic sug-
gestibility is normally distributed with approximately 10–15% of
the population displaying low and high suggestibility and the
remainder exhibiting moderate responsiveness (Laurence et al.,
2008). Hypnotic suggestibility exhibits trait-like stability over
long periods of time (Piccione et al., 1989) and is at least partly
hereditary (Morgan et al., 1970; Rominger et al., 2014).
Nevertheless, hypnotic suggestibility has few known personality
correlates, typically pertaining to absorption in activities, height-
ened responsiveness to social-emotional cues and a propensity
for self-transcendent experiences, although these effects are typi-
cally small in magnitude (Cardeña et al., 2009; Cardeña and
Terhune, 2014; Lynn et al., 2015; Wickramasekera and Szlyk,
2003). Similarly, there are no known robust cognitive correlates
of hypnotic suggestibility (Parris, 2017), although highly sug-
gestible individuals seem to display heightened automaticity
(Braffman and Kirsch, 2001; Dixon and Laurence, 1992), poorer
working and short-term memory (Farvolden and Woody, 2004;
Khodaverdi-Khani and Laurence, 2016; Terhune et al., 2011) and
selectively impaired metacognition (Lush et al., 2016; Terhune
and Hedman, 2017). Although hypnosis shares superficial simi-
larity to meditation, recent research suggests that they are actu-
ally opposing metacognitive phenomena (Lush et al., 2016).
Neurophysiology
During the past two decades, researchers have utilized neuroim-
aging techniques to study the neurophysiological correlates of
response to hypnotic inductions and suggestions and individual
differences in hypnotic suggestibility (Oakley and Halligan,
2013; Terhune et al., 2017). Although the field was traditionally
occupied with the question of whether hypnosis constitutes an
altered state of consciousness, contemporary research has
directed attention toward more substantive questions pertaining
to the correlates, characteristics, and mechanisms of response to
hypnotic suggestions and individual differences in hypnotic sug-
gestibility (Jensen et al., 2017). Accumulating data suggest that a
hypnotic induction may produce a reduction in global, frontal or
frontal-parietal functional connectivity, as measured by resting
state EEG (for a review, see Terhune et al., 2017). Functional
neuroimaging research has further shown that hypnosis seems to
produce a selective reduction in activity of the anterior medial
prefrontal cortex (McGeown et al., 2009; see also Deeley et al.,
2012), which corresponds to the anterior node of the DMN
(Greicius et al., 2009). Other research has similarly observed that
the perception of being deeply hypnotized following an induction
was associated with reduced functional connectivity between
posterior cingulate cortex (PCC) and dorsolateral prefrontal cor-
tex (DLPFC), decreased anterior cingulate cortex (ACC) activa-
tion and increased connectivity between DLPFC and insula
(Jiang et al., 2017). These results suggest that a hypnotic induc-
tion produces in highly suggestible individuals a reduction in
self-related or metacognitive processing (Cardeña et al., 2013;
Pekala and Kumar, 2007), coupled with atypical connectivity of
the executive control network, which may reflect cognitive con-
trol with reduced awareness (Dienes and Perner, 2007). Most
imaging studies indicate that hypnotic suggestions for altered
perception engage neural systems that overlap with those of the
genuine experience: for instance, suggestions for colour halluci-
nations modulate fusiform areas including V4 (Kosslyn et al.,
2000; McGeown et al., 2012) and suggestions for altered pain
perception alter somatosensory areas and ACC (Derbyshire et al.,
2004; Rainville et al., 1997), although the neurophysiological
correlates shared by responses to different hypnotic suggestions
remain elusive (Oakley and Halligan, 2013; Terhune et al., 2017).
Therapeutic potential
In a clinical setting, hypnosis involves the administration of ver-
bal suggestions and metaphors to guide individuals into dynamic,
multimodal experiences with the aim of promoting emotional
catharsis and desirable changes in perceptual experiences, self-
image, behaviours, habits and general health as appropriate to the
presenting symptom or condition (Lynn et al., 2010). Treatment
strategies with hypnosis can include direct suggestion, symptom
substitution, ego-strengthening and hypnoanalytic therapies
(Elkins, 2017). The clinical efficacy of hypnosis is only weakly
predicted by hypnotic suggestibility (Montgomery et al., 2011),
plausibly because responsiveness to therapeutic suggestions is
influenced by a range of non-hypnotic factors, such as patient
motivation and response expectancies (e.g., Lynn et al., 2008).
Moreover, many suggestions utilized in the therapeutic applica-
tion of hypnosis do not require a high level of hypnotic suggest-
ibility (Elkins, 2017). Accordingly, medium suggestible
individuals are capable of responding, and potentially benefiting
from, suggestions administered within clinical contexts (Lynn
et al., 2010). Verbal suggestion can also be applied in the absence
of hypnosis in a variety of contexts (Amigó and Ferrández, 2015;
Peerdeman et al., 2016), thereby potentially removing the need
for the explicit use of hypnosis per se (see also Terhune and
Cardeña, 2016). Although the most recognized use of hypnosis is
in the treatment or management of pain, such as in surgical con-
texts (Faymonville et al., 1995), there is reliable evidence for its
efficacy in treating a range of conditions including acute and
4 Journal of Psychopharmacology 00(0)
chronic pain (Patterson and Jensen, 2003; Tome-Pires and Miro,
2012), post-menopausal hot flashes (Elkins et al., 2013), irritable
bowel syndrome (Schaefert et al., 2014) and enhancement of
immunological functions (Miller and Cohen, 2001). Although
less robust, promising, albeit preliminary, evidence suggests that
hypnosis constitutes a potentially valuable option for treating
depression (Alladin and Alibhai, 2007), anxiety (Hammond,
2010), nicotine addiction (Hasan et al., 2014), symptoms inher-
ent to neurodegenerative disorders such as amyotrophic lateral
sclerosis (Kleinbub et al., 2015) and dermatological problems
(Shenefelt, 2000; for reviews, see Elkins, 2017; Terhune et al.,
2017). Moreover, when hypnosis is used as an adjunct to non-
hypnotic methods, such as cognitive behavioural therapy, thera-
peutic outcomes are often strongly amplified (Kirsch et al.,
1995). In addition, preliminary evidence suggests that suggesti-
bility may influence response to non-suggestion-based treat-
ments (e.g., Nitzan et al., 2015), thus further highlighting the
widespread presence and influence of suggestions in a variety of
therapeutic contexts. Cumulatively, the available evidence indi-
cates that hypnosis and suggestion-based interventions constitute
safe (Bollinger, 2018) and efficacious interventions for treating a
range of psychopathological and somatic symptoms.
Psychedelics and hypnosis
During the 1960–1970s, several studies compared phenomenologi-
cal parallels between psychedelics and hypnosis (Barber, 1970;
Grünholz, 1971; Gubel, 1962; Halpern, 1961; Krippner, 1964) and
explored the potential benefits of combining them in psychotherapy
(Levine and Ludwig, 1966; Ludwig and Levine, 1965; Ludwig
et al., 1969). Particularly relevant is the finding that psychedelics
seem to enhance suggestibility (Middlefell, 1967; Netz and Engstam,
1968; Sjoberg and Hollister, 1965; Solursh and Rae, 1966; Ulett
et al., 1972; Van Nuys, 1972). Other research reported on the use of
hypnosis to recreate psychedelic-like experiences (Aaronson, 1970;
Baumann, 1970; Erickson, 1965; Tart, 1967; Fogel and Hoffer,
1962) or to control, guide and deepen LSD-induced psychedelic
experiences (Fogel and Hoffer, 1962; Levine and Ludwig, 1965;
Levine et al., 1963) and to influence the subjects’ experiential
response to psychedelics with explicit suggestions (Levis and
Mehlman, 1964). Here we revisit this seminal work and relate it to
recent advances in our knowledge of these phenomena.
Hypnodelic treatment technique
Based on previous research on the potential of hypnosis in modu-
lating the effects of LSD (Fogel and Hoffer, 1962), Ludwig and
Levine hypothesised that hypnosis could be used in conjunction
with LSD to enhance therapeutic outcome, an approach known as
the hypnodelic treatment technique (Levine and Ludwig, 1966;
Ludwig et al., 1969; Ludwig and Levine, 1965). They evaluated
the coupling of these approaches in a randomized controlled trial
in which 70 participants with drug addictions were randomly
assigned to one of five treatment conditions: (a) LSD + hypnosis
+ psychotherapy (hypnodelic treatment); (b) LSD + psychother-
apy; (c) LSD alone; (d) psychotherapy; or (e) hypnosis + psycho-
therapy. In the hypnodelic treatment, a 45-minute induction was
administered just after drug administration in order to temporally
coincide the onset of the therapy with the onset of the
psychedelic state. They reported that participants who received
hypnodelic treatment showed greater improvement than those in
the other conditions both at 2 weeks and 2 months post-treatment
(Ludwig and Levine, 1965). All patients had responded posi-
tively on simple suggestibility assessments that ensured a moder-
ate level of hypnotic suggestibility. Hypnotic suggestibility did
not differ across treatment groups although it did seem to contrib-
ute to therapeutic outcomes. Ludwig and Levine proposed that
the enhanced efficacy of hypnodelic treatment technique might
be attributable to the mental calmness arising from hypnosis that
may have better prepared patients to experience the effects of
LSD, patients’ enhanced acceptance of, and control over, the psy-
chedelic experiences, greater participation in the therapeutic pro-
cess, and deeper and more intense experiences afforded with this
approach (Levine and Ludwig, 1966; Ludwig and Levine, 1965).
A second clinical trial on alcoholism failed to report any benefi-
cial effects with conditions (a) to (c) (Ludwig et al., 1969), with
the reason for this failure being unclear. Although preliminary
and limited from a methodological perspective, this line of
research points to the potential utility of coupling psychedelics
and hypnosis, an approach that is likely to benefit considerably
from recent advances in our understanding of both phenomena.
In the following section, we review recent advances in neurophe-
nomenological and clinical research pointing to overlapping
characteristics of psychedelics and hypnosis.
Phenomenology
Levine and Ludwig (1965) reported that LSD and hypnotic
experiences share overlapping phenomenology and this obser-
vation is borne out in recent research. In the context of neutral
hypnosis, with the only suggestion being to go as deeply into
hypnosis as possible, participants frequently report experiential
responses strikingly similar to the phenomenology of psyche-
delic experiences, such as alterations in perception, body image,
imagery, self-awareness, affect, time perception and meaning
(Cardeña, 2005; Cardeña et al., 2013). Beyond the spontaneous
experiential response to an induction, it has been shown that
hypnotic suggestion can be used to experimentally induce psy-
chological states that closely resemble those experienced in
response to psychoactive substances including psychedelics
(Baumann, 1970; Fogel and Hoffer, 1962), narcotics (Ludwig
and Lyle, 1964) and MDMA (Hastings, 2006). Similarly, hyp-
notic suggestions can be used to elicit mystical-type experi-
ences in highly suggestible individuals (Lynn and Evans, 2017;
Sacerdote, 1977; Spanos and Moretti, 1988). Lynn and Evans
(2017) reported that 22% of participants (undergraduate volun-
teers) experienced a ‘complete’ mystical-type experience, based
on the criterion proposed by Barrett et al. (2015). In the same
way as absorption predicts mystical-type experience with
psychedelics, hypnotic suggestibility correlates with the pro-
pensity to experience hypnotically suggested mystical-type
experiences (Lynn and Evans, 2017; Spanos and Moretti, 1988).
Although a recent investigation suggests that non-psychedelic-
induced mystical-type experiences tend to be less intense and
associated with lower positive existential impact than psyche-
delic-induced experiences (Yaden et al., 2017), it has not yet
been determined whether and to what extent hypnotically
induced mystical-type experiences exert long-term beneficial
effects on individuals.
Lemercier and Terhune 5
LSD and mescaline, but not psilocybin, seem to enhance sug-
gestibility to a similar extent as a hypnotic induction (Carhart-
Harris et al., 2015; Netz and Engstam, 1968; Sjoberg and
Hollister, 1965; Solursh and Rae, 1966; Ulett et al., 1972). The
mechanisms underlying this augmentation remain unknown, but
it may be due to a reduction in reality testing, metacognition or
modulation of executive functioning. Nonpharmacological fac-
tors such as expectation, preparation, intention, and physical and
social environment all influence response to hypnosis and psych-
edelics (Kirsch, 2000; Zinberg, 1986). In addition, there is evi-
dence for a shared psychological propensity for response to both
phenomena: absorption, the individual tendency to experience
episodes of intense attentional involvement (Tellegen and
Atkinson, 1974), appears to be a reliable predictor of phenomenal
response to psychedelics (Studerus et al., 2012) as well as hyp-
notic suggestibility (Cardeña and Terhune, 2014; but see Council
et al., 1986; Roche and McConkey, 1990). Despite these com-
monalities, psychedelics and hypnosis clearly differ in their
mode of induction: the former being psychopharmacological and
the latter being suggestion-based and occurring typically in an
interpersonal context. The two phenomena are also temporally
different: a psychedelic experience is limited in time relative to
the metabolism and clearance of the drug from the body whereas
a hypnotic experience can be easily terminated by the participant
or therapist/experimenter at any time (although see Perry, 1977).
Neurophysiology
Neuroimaging studies have shown that both psychedelics and hyp-
nosis affect the activity of several brain areas and networks, includ-
ing prefrontal regions, cingulate cortex and the DMN
(Carhart-Harris et al., 2012, 2016b; Deeley et al., 2012; Hermle
et al., 1992; Jiang et al., 2017; McGeown et al., 2009; Palhano-
Fontes et al., 2015; Pekala and Kumar, 2007; Vollenweider et al.,
1997). Psychedelics seem to affect a larger set of brain regions and
networks than hypnosis and induce broader changes specifically in
frontal regions, medial temporal lobe, occipital cortex, hippocam-
pus and amygdala (Barrett and Griffiths, 2017; Dos Santos et al.,
2016). In addition, spontaneous phenomenological effects shared
by the two phenomena seem to be associated with converse global
functional connectivity patterns. For example, ego-dissolution
under the influence of psychedelics was associated with increased
connectivity (Tagliazucchi et al., 2016) whereas transcendent
experiences following a hypnotic induction were associated with
lower connectivity (Cardeña et al., 2013). One possibility for these
discrepancies is that the relation between anomalous self-aware-
ness and global functional connectivity adheres to an inverted-U
shape with greater aberrations occurring with both lower and
higher connectivity patterns. Alternatively, these differences may
reflect distinct alterations in the experience of the self in these dif-
ferent conditions. Similarities in spontaneous experiential response
to psychedelics and hypnosis may be explained in part by the mod-
ulation of the DMN and global functional connectivity. Prepulse
inhibition (PPI) of the acoustic startle response, a parameter
thought to reflect the early, pre-attentive stage of automatic sen-
sory processing used to assess efficiency of the sensorimotor gat-
ing system, is disrupted in response to psilocybin (Vollenweider
et al., 2007) and LSD (Schmid et al., 2015) and seems to be lower
in highly suggestible individuals (Levin et al., 2011; Lichtenberg
et al., 2008; Storozheva et al., 2018; but see De Pascalis and Russo,
2013). These results suggest a potentially overlapping mechanism
underlying individual differences in hypnotic suggestibility and
responsiveness to psychedelics, which may relate to the psyche-
delic enhancement of suggestibility (Carhart-Harris et al., 2015).
Although the neurophysiological basis of hypnotically induced
mystical-type experiences is unknown (Lynn and Evans, 2017),
hypnotic suggestion often, but not always, produces a similar neu-
rophysiological pattern as the actual phenomenon (Oakley and
Halligan, 2013; Terhune et al., 2017), suggesting the viability of
using hypnotic suggestion to reproduce psychedelics-occasioned
mystical-type experiences (Barrett and Griffiths, 2017).
Neurophenomenological parallels between hypnosis and psyche-
delics seem to offer a valuable platform where these two phenom-
ena could be mutually beneficial to each other.
Future directions
Recent research on psychedelics and hypnosis allows for revisit-
ing their combined use in psychotherapy. Enhanced suggestibility
under psychedelics and hypnosis may have implications for their
use as adjuncts in psychotherapy, where suggestibility plays a sig-
nificant role in therapeutic outcomes (Montgomery et al., 2011).
Researchers and clinicians may already be harnessing the power
of suggestion to modulate set and setting and, in turn, to influence
the phenomenological response to psychedelics. Harnessing the
effects of suggestion more explicitly may facilitate the develop-
ment of a more precise understanding of the pharmacological and
contextual factors influencing the psychedelic experience and a
way to further enhance their therapeutic efficacy. In what follows,
we propose several pathways concerning the combined use of
hypnosis and psychedelics to prepare, guide and integrate the psy-
chedelic experience in order to enhance treatment efficacy.
Hypnosis-based training for participant
preparation
Experience of hypnotically suggested alterations in consciousness,
including phenomenal states resembling psychedelic experiences,
could be used as a preliminary training regimen to familiarize
naïve participants with the experiential effects of psychedelics in a
controlled setting. Such training may better prepare individuals to
participate in psychedelic research or therapy and could potentially
reduce pre- and/or post-treatment anxiety, and participant attrition,
whilst augmenting positive response expectancies and involve-
ment in the psychedelic experience. These complementary effects
could increase the likelihood of safe and profound experiences
and, concomitantly, successful therapeutic outcomes. Moreover,
we expect that similarly to absorption (Studerus et al., 2012), hyp-
notic suggestibility could constitute a valuable predictor of percep-
tual, cognitive, affective and self-related phenomenological
features of the psychedelic experience.
Hypnodelic treatment technique: Using
suggestion to guide psychedelic states
Ludwig and Levine reported that the conjunct use of hypnosis and
psychedelics enabled them to enhance participants’ experiential
responses to LSD, rendering the experience more intense and mal-
leable to control with potentially increased therapeutic efficacy
6 Journal of Psychopharmacology 00(0)
(Levine and Ludwig, 1965; Ludwig and Levine, 1965). Moreover,
as psychedelics seem to increase suggestibility (Carhart-Harris
et al., 2015; Middlefell, 1967; Netz and Engstam, 1968; Sjoberg
and Hollister, 1965; Solursh and Rae, 1966; Ulett et al., 1972; Van
Nuys, 1972), therapeutically coupling the two could further potenti-
ate the impact of suggestions. Harnessing the power of suggestion
to modulate response to psychedelics could exert considerable
effects in enhancing their therapeutic efficacy including by guiding
the psychedelic experience to increase the likelihood of positive
responses, promote, or enhance, mystical-type experiences (e.g.,
Lynn and Evans, 2017) and avoid unwanted experiences. Moreover,
posthypnotic suggestions, including suggestions for how the expe-
rience could be processed afterward in terms of meaning, values
and future life directions, may further aid integration of the experi-
ence and carry over to everyday life. For these reasons, we maintain
that a renewed attention should be directed to the development of a
formalized suggestion-based psychedelic-assisted psychotherapy.
Hypnosis and mild dosages of psychedelics:
Transversal applications
Drug dosage reduction for equivalent treatment outcome is an
important goal in psychopharmacology. At present, little is known
about the neurophenomenological effects (Greiner et al., 1958),
and/or therapeutic potential, of psychedelics at low dosages and
the dose level required to enhance suggestibility is unknown.
Insofar as hypnotic suggestion may be useful in augmenting clas-
sical psychedelic experiences (Levine and Ludwig, 1965), it would
be valuable to determine whether such an approach could be
extended to mild dosages in order to evaluate whether suggestion
can be used to similarly enhance weak psychedelic experiences.
Hypnosis for drug-free re-experiencing of
psychedelic states
Several studies have shown that hypnosis can be used to induce
mystical-type experiences (Lynn and Evans, 2017; Sacerdote,
1977; Spanos and Moretti, 1988). A potential benefit of combin-
ing psychedelics and hypnosis could be to use suggestions to
reproduce such experiences in the days after administration of
psychedelics (e.g., Fogel and Hoffer, 1962; Hastings, 2006). This
approach may afford the potential for patients to re-experience
the associated affective states, with greater control over the post-
administration response to psychedelic-assisted therapy, thereby
providing additional opportunities to harness the positive fea-
tures of psychedelic experiences for therapeutic impact, with the
potential to further enhance outcomes over a sustained period.
Conclusion
Recent clinical research on psychedelic-assisted psychotherapy
and hypnosis demonstrates the value of both methods in the
treatment of a range of conditions with overlapping applica-
tions and neurophenomenological features. Older research on
the overlap of these two phenomena considered against the
backdrop of recent advances clearly points to the potential of
harnessing the power of suggestion to influence the phenome-
nological response to psychedelics. The coupling of psyche-
delics and hypnosis represents a potentially highly fertile
platform for both basic research on alterations in consciousness
as well as their exploitation in therapy and thereby warrants
renewed empirical attention.
Acknowledgements
The authors would like to thank Neiloufar Family and anonymous review-
ers for constructive comments on an earlier draft of this manuscript.
Declaration of conflicting interests
The author(s) declared no potential conflicts of interest with respect to
the research, authorship, and/or publication of this article.
Funding
The author(s) disclosed receipt of the following financial support for the
research, authorship, and/or publication of this article: DBT acknowl-
edges the support of bursary 70/16 from the Bial Foundation.
ORCID iD
Clément E. Lemercier https://orcid.org/0000-0002-7113-3543
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